| NPI | 1457667818 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: VA 0203012949) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: CA INT23739) |
| Enumeration Date | 2010-08-24 |
| Last Update Date | 2010-08-24 |